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• W2116788875 abstract "Free AccessSurgeryMild Obstructive Sleep Apnea Syndrome Should Not Be Treated Michael R. Littner, M.D. Michael R. Littner, M.D. Address correspondence to: Michael R. Littner, M.D., Professor of Medicine, David Geffen School of Medicine at UCLA, VA GLAHS (111P), 16111 Plummer Street, Sepulveda, CA 91343 David Geffen School of Medicine, University of California, Los Angeles, CA Search for more papers by this author Published Online:April 15, 2007https://doi.org/10.5664/jcsm.26794Cited by:21SectionsPDF ShareShare onFacebookTwitterLinkedInRedditEmail ToolsAdd to favoritesDownload CitationsTrack Citations AboutINTRODUCTIONThe diagnosis of obstructive sleep apnea (OSA) generally requires a presenting symptom or symptoms and the demonstration of apneas and/or hypopneas per hour of sleep (AHI) on a formal sleep study. The diagnosis of mild OSA is not well defined but in a 1999 report of the American Academy of Sleep Medicine (AASM), definitions of mild OSA by symptoms of sleepiness and AHI were proposed. These definitions will be used in this review.Mild symptoms were an unwanted sleepiness or involuntary sleep episodes occurring during activities that require little attention. Examples included sleepiness that is likely to occur while watching television, reading, or traveling as a passenger. Symptoms produce only minor impairment of social or occupational function. Mild levels of AHI were 5 to 15 and moderate were 15 to 30.1Although there are many studies that address treatment of OSA, relatively few focus on mild OSA. In addition, there are several potential treatment modalities. For purposes of this review, continuous positive airway pressure (CPAP) will be the main treatment comparator. Interventions such as attempted weight loss, sleep position, sleep hygiene, etc. will be considered part of usual care and not specific treatment of OSA.In 2006, The AASM published evidence-based practice parameters (recommendations) on the use of CPAP in the treatment of OSA. The recommendation for mild OSA was as follows2:“CPAP is recommended for the treatment of mild OSA (Option). This recommendation as an option is based on mixed results in 2 Level I and 3 Level II outcome studies in patients with mild OSA. An option is a patient-care strategy, which reflects uncertain clinical use.” “The term option implies either inconclusive or conflicting evidence or conflicting expert opinion.”The evidence review3 that supported the above recommendation concluded as follows:“The sole study that examined change in blood pressure associated with treatment in milder OSA using a tablet placebo failed to show differences between CPAP treatment and placebo. The 2 Level II studies that evaluated the impact of CPAP versus placebo on heart rate produced conflicting results. Therefore, the impact of CPAP treatment on cardiovascular risk and associated organ dysfunction in milder OSA is unknown.” and “The 3 Level I studies and 3 Level II studies that were restricted to patients with mild to moderate OSA found that CPAP reduced AHI but did not improve objective sleepiness or blood pressure. Conflicting results were found for subjective measures of sleepiness, neurobehavioral performance, mood and quality of life. Thus, it remains unclear whether CPAP has utility across outcomes for this level of disease severity.” Of note, the Level I and II studies were randomized controlled trials but the design (usually a greater sample size) of Level I studies provided stronger evidence than Level II studies.In summary, none of AHI, objective sleepiness, systemic blood pressure, subjective sleepiness, neurobehavioral performance, mood, or quality of life were obviously improved by CPAP in mild to moderate OSA.The review concluded further “There are no Level I or II studies that have examined the efficacy or effectiveness of CPAP treatment in OSA patient with an AHI < 5. There have been several Level III studies as described in a large review paper that have examined the use of CPAP in Upper Airway Resistance Syndrome (with an AHI <5) and in subjects with an AHI <10. There is insufficient evidence to draw conclusions regarding the efficacy and/or effectiveness of CPAP treatment in this population.”Apart from the difficulty in documenting improvement with CPAP in mild OSA, the issue of acceptance and adherence should be taken into account. For example, a randomized study of the diagnosis of OSA by either polysomnography or home portable monitor followed by autotitrating PAP treatment (APAP) was performed.4 Of 32 patients undergoing polysomnography with an AHI less than 10 per hour of sleep, 10 had improved quality of life at 4 weeks and 4 continued to adhere with APAP for 3 or more months. The comparable figures for diagnosis by home monitoring were 69, 18 and 3. In summary, patients with mild OSA are not usually improved by PAP treatment and even if improved are not likely to be adherent.Cohort studies of mortality with CPAP treatment suggest that only those patients with an AHI greater than 30 or an AI greater than 20 have a reduced mortality. For example, in a retrospective analysis of OSA only those patients with an AI greater than 20 had substantial mortality over 9 years and those patients also benefited from treatment with CPAP or tracheostomy.5 More recently, a prospective cohort study indicated that patients with a previous transient ischemic attack or stroke and OSA and an AHI equal to or greater than 30 had a reduced mortality compared to those with an AHI of 5 to 30.6 Another prospective nonrandomized study7 included OSA untreated with CPAP, OSA treated with CPAP, simple snorers and healthy controls. This study provided evidence that CPAP was effective in preventing cardiovascular events or death in OSA patients with an AHI greater than 30 but ineffective in those with an AHI less than 30. The rates of events and deaths were statistically similar in all groups except those with an AHI greater than 30 untreated with CPAP. This group had an increased incidence of cardiovascular events and mortality.The question may be raised about other modalities to treat mild OSA. As mentioned, “conservative” or medical therapy was considered to be usual care. Such care may be effective in improving symptoms in patients with OSA. A recent review and practice parameter indicated that weight loss, positional therapy in patients with supine OSA, and nasal corticosteroids in patients with allergic rhinitis may be effective.8 The use of CPAP has been compared to a dental appliance (also called mandibular advancement device, mandibular advancement splint, or mandibular repositioning appliance) and found to be superior, particularly with respect to AHI.9 A dental appliance has been compared to surgery (uvulopalatopharyngoplasty) and found to be superior.10 This suggests a hierarchy of effectiveness of CPAP > dental appliance > surgery. Since CPAP is not effective in treating mild to moderate OSA, it is unlikely that dental appliances or surgery would also be effective.In summary, the benefits of CPAP compared to usual care with respect to daytime sleepiness, symptoms, cardiovascular risk, quality of life and mortality are minimal or nonexistent in patients with mild obstructive sleep apnea and the adherence to PAP at three months appears inadequate.I conclude that first line treatment of mild obstructive sleep apnea should be medical. CPAP and other modalities such as a dental appliance or surgery should be reserved for failed treatment in highly selected cases.Disclosure StatementThis is not an industry supported study. Dr. Littner has indicated no financial conflicts of interest.REFERENCES1 The Report of an American Academy of Sleep Medicine Task Force Sleep–related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical researchSleep19992266789, 10450601 CrossrefGoogle Scholar2 Kushida CA, Littner MR, Hirshkowitz M, et al.Practice parameters for the use of continuous and bilevel positive airway pressure devices to treat adult patients with sleep-related breathing disorders. An American Academy of Sleep Medicine ReportSleep20062937580, 16553024 CrossrefGoogle Scholar3 Gay P, Weaver T, Loube D, Iber C, et al.Evaluation of positive airway pressure treatment for sleep related breathing disorders in adults. A Review by the Positive Airway Pressure Task Force of the Standards of Practice Committee of the American Academy of Sleep MedicineSleep200629381401, 16553025 CrossrefGoogle Scholar4 Whitelaw WA, Brant RF, Flemons WWClinical usefulness of home oximetry compared with polysomnography for assessment of sleep apneaAm J Respir Crit Care Med200517118893, 15486338 CrossrefGoogle Scholar5 He J, Kryger MH, Zorick FJ, Conway W, Roth TMortality and apnea index in obstructive sleep apnea. Experience in 385 male patientsChest198894914, 3289839 CrossrefGoogle Scholar6 Parra O, Arboix A, Montserrat JM, Quinto L, Bechich S, Garcia-Eroles LSleep-related breathing disorders: impact on mortality of cerebrovascular diseaseEur Respir J20042426772, 15332396 CrossrefGoogle Scholar7 Marin JM, Carrizo SJ, Vicente E, Agusti AGLong-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational studyLancet20053659464104653, 15781100 CrossrefGoogle Scholar8 Morgenthaler TI, Kapen S, Lee-Chiong T, et al.Practice parameters for the medical therapy of obstructive sleep apnea. Standards of Practice Committee of the American Academy of Sleep MedicineSleep20062910315, 16944671 CrossrefGoogle Scholar9 Barnes M, McEvoy RD, Banks S, et al.Efficacy of positive airway pressure and oral appliance in mild to moderate obstructive sleep apneaAm J Respir Crit Care Med200417065664, 15201136 CrossrefGoogle Scholar10 Walker-Engstrom ML, Tegelberg A, Wilhelmsson B, Ringqvist I4-year follow-up of treatment with dental appliance or uvulopalatopharyngoplasty in patients with obstructive sleep apnea: a randomized studyChest200212173946, 11888954 CrossrefGoogle Scholar Previous article Next article FiguresReferencesRelatedDetailsCited by Cerebral white matter diffusion properties and free‐water with obstructive sleep apnea severity in older adultsBaril A, Gagnon K, Descoteaux M, Bedetti C, Chami S, Sanchez E, Montplaisir J, De Beaumont L, Gilbert D, Poirier J, Pelleieux S, Osorio R, Carrier J and Gosselin N Human Brain Mapping, 10.1002/hbm.24971, Chronic insomnia remitting after maxillomandibular advancement for mild obstructive sleep apnea: a case seriesProothi M, Grazina V and Gold A Journal of Medical Case Reports, 10.1186/s13256-019-2182-9, Vol. 13, No. 1, Online publication date: 1-Dec-2019. A Novel Decision Making Procedure during Wakefulness for Screening Obstructive Sleep Apnea using Anthropometric Information and Tracheal Breathing SoundsElwali A and Moussavi Z Scientific Reports, 10.1038/s41598-019-47998-5, Vol. 9, No. 1, Online publication date: 1-Dec-2019. Adherence to CPAPBakker J, Weaver T, Parthasarathy S and Aloia M Chest, 10.1016/j.chest.2019.01.012, Vol. 155, No. 6, (1272-1287), Online publication date: 1-Jun-2019. Determining Breathing Sound Features Representative of Obstructive Sleep Apnea During Wakefulness with Least Sensitivity to Other Risk FactorsElwali A and Moussavi Z Journal of Medical and Biological Engineering, 10.1007/s40846-018-0410-1, Vol. 39, No. 2, (230-237), Online publication date: 1-Apr-2019. Using tracheal breathing sounds and anthropometric information for screening obstructive sleep apnoea during wakefulnessElwali A, Meza-Vargas S and Moussavi Z Journal of Medical Engineering & Technology, 10.1080/03091902.2019.1617799, Vol. 43, No. 2, (111-123), Online publication date: 17-Feb-2019. Sleep hygiene-related conditions in patients with mild to moderate obstructive sleep apneaJung S, Kim H, Min J, Hwang K and Kim S Auris Nasus Larynx, 10.1016/j.anl.2018.06.003, Vol. 46, No. 1, (95-100), Online publication date: 1-Feb-2019. A Conditional Inference Tree Model for Predicting Sleep-Related Breathing Disorders in Patients With Chiari Malformation Type 1: Description and External ValidationFerré Á, Poca M, de la Calzada M, Moncho D, Urbizu A, Romero O, Sampol G and Sahuquillo J Journal of Clinical Sleep Medicine, Vol. 15, No. 01, (89-99), Online publication date: 15-Jan-2019. Increased severity of obstructive sleep apnea is associated with less anxiety and depressionBjorvatn B, Rajakulendren N, Lehmann S and Pallesen S Journal of Sleep Research, 10.1111/jsr.12647, Vol. 27, No. 6, (e12647), Online publication date: 1-Dec-2018. Predictors of Obstructive Sleep Apnea on a Home Sleep Apnea Test After a Negative Attended PolysomnographyLipatov K, Hayek A, Ghamande S, Boethel C, Chen W and Jones S Journal of Clinical Sleep Medicine, Vol. 14, No. 11, (1889-1894), Online publication date: 15-Nov-2018. Obstructive sleep apnea and cortical thickness in females and malesMacey P, Haris N, Kumar R, Thomas M, Woo M, Harper R and Romigi A PLOS ONE, 10.1371/journal.pone.0193854, Vol. 13, No. 3, (e0193854) Metabolic Profile in Patients with Mild Obstructive Sleep ApneaSilva L, Guimarães T, Luz G, Coelho G, Badke L, Almeida I, Millani-Carneiro A, Tufik S, Bittencourt L and Togeiro S Metabolic Syndrome and Related Disorders, 10.1089/met.2017.0075, Vol. 16, No. 1, (6-12), Online publication date: 1-Feb-2018. The association of obstructive sleep apnea and renal outcomes—a systematic review and meta-analysisHwu D, Lin K, Lin K, Lee Y and Chang Y BMC Nephrology, 10.1186/s12882-017-0731-2, Vol. 18, No. 1, Online publication date: 1-Dec-2017. Treatment of primary aldosteronism is associated with a reduction in the severity of obstructive sleep apnoeaWolley M, Pimenta E, Calhoun D, Gordon R, Cowley D and Stowasser M Journal of Human Hypertension, 10.1038/jhh.2017.28, Vol. 31, No. 9, (561-567), Online publication date: 1-Sep-2017. Comparison of American Academy of Sleep Medicine (AASM) versus Center for Medicare and Medicaid Services (CMS) polysomnography (PSG) scoring rules on AHI and eligibility for continuous positive airway pressure (CPAP) treatmentKorotinsky A, Assefa S, Diaz-Abad M, Wickwire E and Scharf S Sleep and Breathing, 10.1007/s11325-016-1327-y, Vol. 20, No. 4, (1169-1174), Online publication date: 1-Dec-2016. Short-Term Variability in Apnea-Hypopnea Index during Extended Home Portable MonitoringPrasad B, Usmani S, Steffen A, Van Dongen H, Pack F, Strakovsky I, Staley B, Dinges D, Maislin G, Pack A and Weaver T Journal of Clinical Sleep Medicine, Vol. 12, No. 06, (855-863), Online publication date: 15-Jun-2016. An Official American Thoracic Society Research Statement: Impact of Mild Obstructive Sleep Apnea in AdultsChowdhuri S, Quan S, Almeida F, Ayappa I, Batool-Anwar S, Budhiraja R, Cruse P, Drager L, Griss B, Marshall N, Patel S, Patil S, Knight S, Rowley J and Slyman A American Journal of Respiratory and Critical Care Medicine, 10.1164/rccm.201602-0361ST, Vol. 193, No. 9, (e37-e54), Online publication date: 1-May-2016. Prevalence of excessive sleepiness is higher whereas insomnia is lower with greater severity of obstructive sleep apneaBjorvatn B, Lehmann S, Gulati S, Aurlien H, Pallesen S and Saxvig I Sleep and Breathing, 10.1007/s11325-015-1155-5, Vol. 19, No. 4, (1387-1393), Online publication date: 1-Dec-2015. Berry R Obstructive Sleep Apnea Treatment Overview and Medical Treatments Fundamentals of Sleep Medicine, 10.1016/B978-1-4377-0326-9.00018-X, (299-312), . Shin C and Lee J Management of Sleep Disorders-Sleep Technology on Positional Therapy Introduction to Modern Sleep Technology, 10.1007/978-94-007-5470-6_6, (105-120), . Treatment of obstructive sleep apnoea for chronic cough in childrenTeoh L, Hurwitz M, Acworth J, van Asperen P and Chang A Cochrane Database of Systematic Reviews, 10.1002/14651858.CD008182.pub2 Volume 03 • Issue 03 • April 15, 2007ISSN (print): 1550-9389ISSN (online): 1550-9397Frequency: Monthly Metrics History Published onlineApril 15, 2007 Information© 2007 American Academy of Sleep MedicinePDF download" @default.
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